Gait deviations in amputees
Original Editor - Abby Cain as part of the WCPT Network for Amputee Rehabilitation Project
Top Contributors - Admin, Shaimaa Eldib, Kalyani Yajnanarayan, Naomi O'Reilly, Kim Jackson, Tarina van der Stockt and Tony Lowe
Introduction[edit | edit source]
While assessing amputee gait it is important to be aware of normal gait and how normal gait in the amputee is affected. You can learn about this on the Gait in prosthetic rehabilitation page.
Furthermore there may be deviations which an amputee will adopt to compensate for the prosthesis, muscle weakness or tightening, lack of balance and fear. These deviations create an altered gait pattern and it is important that these are recognised, as rehabilitation of the gait will need to encompass corrections of these deviations[1][2].
Common deviations are listed in the tables below:
Transtibial[edit | edit source]
Name | Description | Causes | Illustration |
Excessive Toe Out | External rotation of the prosthesis at heel strike |
Heel to hard Plantar flexion bumper too hard Socket too loose[3] |
|
Knee fully extended at heel strike |
Faulty suspension of the prosthesis - too soft heel cushion or plantar flexor bumpers Foot placement too far forward on stepping Lack of pre-flexion of the socket Discomfort/pain |
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Excess Knee Flexion | Increased knee flexion at heel strike, patient feels as though walking downhill |
Faulty suspension of prosthesis Prosthetic foot set in too much dorsiflexion Stiff heel cushion Flexion contracture of the knee |
|
External Rotation of Foot at Heel Strike | Rotation of foot at heel strike |
Heel too hard Loose socket[4] |
|
x | Knee flexion ‘jerky’ in presentation during heel strike to foot flat | Weak Quadriceps[2] | |
x | Abrupt knee flexion as foot moves in flat foot contact with the floor |
Excessive dorsiflexion of the prosthetic foot Foot too posterior in relation to socket of the prosthesis Lack of suspension in the prosthesis Lack of cushion due to the shoe Heel of the shoe too high[2] |
|
x | Knee stays extended from heel strike to flat foot contact |
Step length too long Foot too anterior on the prosthesis Foot too planter flexed on the prosthesis Heel too soft Discomfort when flexing the knee in the prosthesis |
|
x | Amputee drops into the socket as the foot moves into flat foot |
Lack of prosthetic socks Suspension loose Faulty socket |
|
Valgus/Varus Moment | Knee shifts medially or laterally during prosthetic stance phase |
Foot placement (medial placement causes lateral thrust and vice versa) Foot alignment on the prosthesis |
|
Drop Off | Heel off occurs too early causing early knee flexion |
Foot too posterior on the prosthesis in relation to the socket Excessive dorsiflexion of the foot on the prosthesis |
|
Knee Hyperextension | Delayed heel causing hyperextension of the knee, walking up hill sensation |
Foot set too far forward on the prosthesis in relation to socket Too hard a heel cushion Too much plantar flexion on the foot[3] |
|
x | The socket drops down off the limb after ‘toe off’ |
Socket too lose Not enough prosthetic socks[2] |
|
Whip | During swing phase foot ‘whips’ laterally or medially |
Poor suspension |
|
Pistoning | tibia moves vertically during alternately weight bearing and non-weight bearing periods of gait |
Socket too large Suspension inadequate |
Transfemoral Gait Deviations[edit | edit source]
Name | Description | Causes | Illustration |
Socket too loose Poor limb control Alignment of foot on the prosthesis Heel of the prosthesis too hard[5] |
|||
Prosthetic Instability | The prosthetic knee has a tendency to buckle on weight bearing |
Knee set too far anterior |
|
Foot Slap | Foot progresses too quickly from heel strike to foot flat, creating a slapping noise |
Patient forcing foot contact to gain knee stability |
|
Abducted Gait | Increased base of support during mobility, prosthetic foot placement is lateral to the normal foot placement during the gait cycle[5] |
Prosthesis too long |
|
Lateral Trunk Bending | Trunk flexes towards prosthesis during prosthetic stance phase |
Prosthesis too short |
|
Anterior Trunk Bending | Trunk flexes forwards during prosthetic stance phase | ||
Excessive pelvic lift on heel lift on prosthetic side |
Toe lever too long[2] |
||
Pelvic dip on heel lift on prosthetic side |
Toe lever too short[2] |
||
Increased Lumbar Lordosis | Lumbar lordosis is exaggerated during prosthetic stance phase |
Poor shaping of posterior wall of the prosthesis or pain on ischial weight bearing, resulting in anterior pelvic rotation |
|
Whip (during swing phase) | At toe off heel moves laterally (lateral whip) or medially (medial whip) |
Prosthetic knee alignment |
|
Socket dropping off when prosthesis lifted |
Insufficient suspension |
||
Excessive Heel Rise | Prosthetic heel rises more than sound side |
Lack of friction on prosthetic knee |
|
Reduced Heel Rise | Prosthetic heel does not rise as much as sound side |
Locked knee |
|
Circumduction | Lateral curvature of swing phase of prosthesis |
Prosthesis too long |
|
Vaulting | Amputee rises onto toe of the non prosthetic limb during prosthetic swing phase |
Prosthesis too long |
|
Forcible impact as knee goes into extension at end of terminal swing phase, just before heel strike |
Lack of friction of knee flexion |
Both Transfermoral and Transtibial[edit | edit source]
Steps are of uneven duration or length, usually a short stance phase on the prosthetic side
Name | Description | Causes | Illustration |
Uneven Step Length | Steps are of uneven duration or length, usually a short stance phase on the prosthetic side |
Fixed flexion deformity at knee Insufficient friction of prosthetic knee creating an increased step length on prosthetic side, Hip flexion contracture Pain leading to decreased weight bearing on prosthetic side[2][5] Fear Poor balance Painful poorly fitting socket |
|
Uneven Arm Swing | Arm on the prosthetic side is held close to the body |
Poor prosthetic fit Poor balance Fear Habit[5] |
|
Unequal weight bearing/reduced stance phase on prosthesis |
Poor fitting socket leading to reduced stability Pain Muscle weakness Poor balance Fear and insecurity Poor extension aid or insufficient knee friction resulting in early excessive heel off and reduce stance time on prosthesis Inadequate prosthetic foot position[5] |
This is not an exhaustive list and the deviation described for each level of amputation is not exclusive to that level, but is more likely to occur for that amputation.f
- ↑ Cite error: Invalid
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- ↑ 3.0 3.1 3.2 3.3 3.4 Berger N. Analysis of Amputee Gait. Chapter 14. Atlas of limb prosthetics: Surgical, Prosthetic and rehabilitation Principles. Abridged version. O and P Virtual library http://oandplibrary.org/alp/chap14-01.asp (accessed 5 February 2015)
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 4.14 Hunter New England. NSW Health Duff K. Prosthetic gait deviations. Page link on Australian Physiotherapist in Amputee Rehabilitation. http://www.austpar.com/portals/gait/docs-and-presentations/ProstheticGaitDeviations.pps (accessed 6 February 2015)
- ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 5.13 Evans S. Prosthetics Education Session. July 2012. Ottobock